Examining racial segregation and underlying mechanisms related to VCID and incident stroke in the REGARDS study

REGARDS 研究中检查种族隔离以及与 VCID 和中风事件相关的潜在机制

• 批准号: 10474231
• 负责人: NATALIE COLABIANCHI
• 金额: $ 225.82万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474231
• 关键词: Address; Adult; Affect; Age; Ancillary Study; Area; Attention; Behavioral; Biological; Black American; Black Populations; Black race; Blood Vessels; Cardiovascular system; Cerebrovascular Trauma; Cerebrum; Child; Chronic Disease; Clinical; Cognitive; Communities; County; Crime; Data; Dementia; Development; Diabetes Mellitus; Discrimination; Disease; Educational Status; Enrollment; Etiology; Exposure to; Federal Government; Food; Geography; Goals; Health; Health behavior; Healthcare; Hypertension; Impaired cognition; Individual; Inequality; Institutes; Institution; Intervention; Investments; Legal; Life; Life Cycle Stages; Link; Local Government; Location; Long-Term Effects; Longitudinal cohort; Measures; Mediating; Mediator of activation protein; Neighborhoods; Neurologic; Not Hispanic or Latino; Outcome; Parents; Participant; Pathway interactions; Persons; Physical activity; Plant Roots; Policies; Population Study; Privatization; Public Health; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Resources; Risk; Risk Factors; Role; Sampling; Schools; Shapes; Social Environment; Social Network; Social Policies; Social Work; Social support; State Government; Stroke; Stroke Belt; Structural Racism; United States; United States National Institutes of Health; base; black/white disparity; built environment; cerebrovascular; cohort; cost effective; experience; health inequalities; neuropathology; perceived discrimination; programs; prospective; racial disparity; residence; residential segregation; resilience; school district; segregation; social cohesion; social culture; social engagement; spatial epidemiology; stroke risk; vascular cognitive impairment and dementia; virtual

Racial inequity in the development of neurological conditions as people age is a major public health issue. While many individual risk factors have been identified as predictors of both vascular contributions to cognitive impairment and dementia (VCID), as well as stroke, these individual factors do not fully explain the stark Black- White disparities existing in these outcomes. Moreover, the structural mechanisms shaping these outcomes are far less understood; in particular, the racially unequal socio-environmental contexts that limit opportunities and resources based on race. Race-based school segregation and racial residential segregation (RRS) are two, critical, structural racism and discrimination (SRD) factors of hypothesized importance in how SRD contributes to inequalities in VCID and stroke, yet few studies exist in this area. At the intersection of chronic disease, life course, and spatial epidemiology emerges a unique opportunity to address this critical gap. This study leverages an ongoing, large-scale, population-based study: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. REGARDS is a national sample of over 30,000 adults (45 years and older) with oversamples of persons self-identifying as non-Hispanic Black and people living in the stroke belt. The proposed study takes advantage of the longitudinal assessments of both VCID and stroke in this diverse cohort, and several other retrospective and prospective data related to biological, clinical (e.g., vascular health conditions), behavioral (e.g., health behaviors), socio-cultural (e.g., social support, social cohesion, perceived discrimination, social networks), and built and social environment (BSE) factors across multiple levels of influence (individual, interpersonal, community, and societal) collected through the parent study and two ancillary studies. These data include state-based and school-level school segregation measures for each school participants attended; objective, county-level educational quality measures for each year of schooling; historical participant residences that will be used to create a life course RRS exposure (median of 51 years) in the proposed study; and 9 BSE measures (food retail, parks, crime, commercial physical activity, healthcare, neighborhood SES, places of worship, social engagement, and social service institutions) for over 40,000 geocoded locations in middle and older ages that will be expanded upon in the proposed study via additional locations and years of data. The proposed study aims to: 1) Determine the association between school segregation on incident VCID and incident stroke later in life; the potential mediating role of educational quality; and to examine moderation by race, 2) Examine the association of RRS over the life course on incident VCID and incident stroke; and to examine moderation by race, and 3) Explore features of the residential neighborhood and interpersonal factors that may mediate the link between RRS in middle and older ages and incident VCID and stroke; and to examine moderation by race. This state-of-the-art study will identify pathways through which SRD contributes to VCID and stroke, the protective resilience factors, and points of intervention.

随着人们年龄的增长，神经系统疾病的发展存在种族不平等，这是一个重大的公共卫生问题。 虽然许多个体风险因素已被确定为血管对认知的贡献的预测因子 损伤和痴呆（VCID）以及中风，这些个体因素并不能完全解释明显的黑人- 这些结果中存在白人差异。此外，塑造这些结果的结构机制 远不被理解；特别是，种族不平等的社会环境背景限制了机会 和基于种族的资源。基于种族的学校隔离和种族居住隔离（RRS） 两个关键的、结构性种族主义和歧视（SRD）因素在SRD如何发挥作用方面具有假设的重要性 导致 VCID 和中风的不平等，但该领域的研究很少。在慢性病的交叉点 疾病、生命历程和空间流行病学为解决这一关键差距提供了独特的机会。这 研究利用了一项正在进行的、大规模的、基于人群的研究：地理和种族的原因 中风差异（问候）研究。 REGARDS 是一个包含超过 30,000 名成年人（45 岁以上）的全国样本 年龄较大），对自我认定为非西班牙裔黑人和生活在中风带的人进行了过度采样。 拟议的研究利用了 VCID 和中风在这种多样化的情况下的纵向评估 队列，以及其他一些与生物学、临床（例如血管健康）相关的回顾性和前瞻性数据 条件）、行为（例如健康行为）、社会文化（例如社会支持、社会凝聚力、感知 歧视、社交网络）以及跨多个层面的建筑和社会环境（BSE）因素 通过家长研究收集的影响力（个人、人际、社区和社会）和两个 辅助研究。这些数据包括各州和学校层面的学校隔离措施 学校参加者出席；每年学校教育的客观县级教育质量衡量标准； 历史参与者居住地，将用于创建生命历程 RRS 暴露（中位数 51 年） 拟议的研究；和 9 项 BSE 措施（食品零售、公园、犯罪、商业体育活动、医疗保健、 社区 SES、礼拜场所、社会参与和社会服务机构）超过 40,000 中老年人的地理编码位置将在拟议的研究中通过额外的方法进行扩展 数据的位置和年份。拟议研究的目的是： 1）确定学校之间的关联 对晚年发生的 VCID 事件和中风事件进行隔离；教育质量的潜在中介作用； 并检查种族的调节，2) 检查生命历程中 RRS 与事件 VCID 的关联 和意外中风；并检查种族的适度性，以及 3) 探索住宅的特点 邻里和人际因素可能介导中老年 RRS 之间的联系 VCID 事件和中风；并通过种族来检验节制。这项最先进的研究将确定途径 SRD 对 VCID 和中风的影响、保护弹性因素和干预点。